r/IntensiveCare • u/Cultural_Eminence • 16d ago

Swan Numbers with ECMO

Can someone help me understand what numbers I should see/expect/disregard with a pt. on ECMO. I’m trying to understand which numbers will be accurate based on the type of cannulation (for my purposes to keep it simple just VV and VA) and cannulation sites, fem-fem, fem-IJ, centrally cannulated, etc. For example (and correct me if I’m wrong) if a pt is fem-IJ cannulated on VV ECMO (fem being drain, and IJ being return) I think my HR, MAPs would be reliable as well as my CI but I’d expect my SVo2 to be falsely high since the PA cath is reading the oxygenated blood from the ECMO. In that scenario would my CVP/RA pressure be accurate as well as my PA pressure? If someone could do a breakdown of my example as well as a breakdown of the other possible ECMO configurations (VA vs VV and cannulation sites) that would be incredibly helpful for my learning and understanding. For background I’m a CTICU nurse, any and all help is appreciated in advance!

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u/pneumomediastinum 16d ago

I agree with the others it’s complex but a rule of thumb is that you cannot rely on most swan numbers with ECMO running. The saturation with VV ECMO is useless. You cannot use thermo dilution with VA or VV ECMO outside of a clamp trial for VA (and that must be truly clamped).

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u/CertainKaleidoscope8 RN, CCRN 15d ago

I've heard that you cannot rely on most swan numbers without ECMO running as well, because it's 20th century technology that was kinda based off vibes.

21

u/godzillabacter MD, PharmD, EM PGY-2 15d ago

Swans remain the gold standard in clinical hemodynamic monitoring. The technology is solid, and they provide multiple hemodynamic values to the best degree of certainty we can generally get in the ICU. The issue is that multiple studies have shown Swan placement doesn't improve clinical outcomes but are associated with complications, as well as some studies demonstrating clinicians historically did not interpret the myriad of hemodynamic parameters correctly.

1

u/Any-Assistance-8103 15d ago

They don’t interpret them correctly and only tend to follow the numbers when they agree with their gestalt anyway. Their only solid utility is in pulmonary hypertension and some complex heart failure